Agnieszka Rydlewska

Comparison of invasive and non-invasive measurements of haemodynamic parameters in patients with advanced heart failure.

Aim Measurement of haemodynamic parameters using a Swan–Ganz catheter is of clinical importance in patients with advanced heart failure; however, its applicability is limited due to its invasiveness. The aim of the study was to estimate the concordance between invasive and non-invasive measurements of haemodynamic parameters in patients with advanced heart failure. Methods and results We examined 25 patients with advanced heart failure (20 men, age: 64 ± 11 years, New York Heart Association class III/IV: 88/12%, left ventricular ejection fraction: 37 ± 20%), 13 (52%) demonstrated decompensated heart failure. Resting haemodynamic parameters were measured simultaneously using two methods: an invasive Swan–Ganz catheterization and a thermodilution technique; and a non-invasive recording using a device for finger arterial pressure waveform analysis. The following parameters were analysed: stroke volume (SV, ml), cardiac output (CO, l/min) and systemic vascular resistance (SVR, dyne × s/cm5). The concordance between these two methods was assessed using the variability coefficient calculated according to a Bland–Altman method. Comparing the invasive and non-invasive measures, variability coefficients were: 13, 18 and 11% for SV, SVR and CO, respectively. Similar variability coefficients were obtained when invasive and non-invasive measurements were compared in prespecified subgroups of patients, distinguished based on the presence of decompensation, atrial fibrillation and values of SBP. Conclusions Evaluation of haemodynamic parameters using a non-invasive method based on a pressure pulse contour model reveals an adequate concordance with the measures obtained using an invasive approach. Our results suggest that a non-invasive method for haemodynamic monitoring could be applied in clinical practice in patients with advanced heart failure.

Circulating testosterone and estradiol, autonomic balance and baroreflex sensitivity in middle-aged and elderly men with heart failure.

Abstract Background: Heart failure (HF) is considered as a cardiogeriatric syndrome. Its fundamental pathophysiological feature is autonomic imbalance (and associated abnormalities within cardiovascular reflex control), but recent evidence suggests the involvement of deranged hormone metabolism. Both these neural and endocrine pathologies have serious clinical and prognostic consequences in patients with HF. We investigated the relations between autonomic status, baroreflex sensitivity (BRS) and hormone status in men with mild systolic HF. Methods: We examined 46 men with stable systolic HF (age: 62 ± 10 years, NYHA class I/II: 10/36 [22%/78%], ischemic aetiology: 72%, left ventricular ejection fraction: 32 ± 8%). Serum hormone levels (i.e. total testosterone [TT], dehydroepiandrosterone sulphate [DHEAS], oestradiol [E2], insulin-like growth factor type 1 [IGF-1] and cortisol) were assessed using immunoassays. Estimated free testosterone (eFT) was estimated using the Vermeulen’s equation. Heart rate variability (HRV) was assessed in time and frequency domains, based on 10-min resting recordings. BRS was estimated using the sequence method (BRS-Seq) and the phenylephrine test (BRS-Phe). Results: Deficiencies in circulating TT, eFT, DHEAS and IGF-1 (defined as a serum hormone ≤the 10th percentile calculated for the adequate age category in the cohort of healthy men) were found in respectively 13%, 30%, 55% and 93% of men with systolic HF. Serum SHBG ≥50 nmol/L and cortisol ≥700 nmol/L characterised, respectively 44% and 29% of men with HF. In multivariable models after the adjustment for clinical variables, the following relationships were found in examined men: DHEAS and SDNN (time domain of HRV defined as a standard deviation of average R–R intervals) (β = 0.29, p = 0.03); E2 and: HRV-LF (ms2) (β = 0.37, p = 0.01), HRV-HF (ms2) (β = 0.44, p = 0.02) and BRS-Phe (β = 0.51, p = 0.008); TT and: HRV-HF (%) (β = 0.35, p = 0.02), HRV-LF/HF ratio (β = −0.35, p = 0.02) and BRS-Seq (β = 0.33, p = 0.04). Conclusions: The observed associations between reduced circulating androgens, oestrogens and lower HRV and depleted BRS, irrespectively of HF severity suggest the pathophysiological links between these two mechanisms. These results constitute the premises to investigate whether the pharmacological supplementation of depleted hormones would enable to restore the autonomic balance and improve the efficacy of reflex control within the cardiovascular system in men with systolic HF.

Health locus of control and the sense of self-efficacy in patients with systolic heart failure: a pilot study

Background Treatment of heart failure (HF) requires the lifelong adherence to medical self-care regimes. The objective of this study was to examine health-control beliefs and the sense of self-efficacy (psychological features particularly important for efficient compliance among patients suffering from chronic diseases) in patients with systolic HF in relation to clinical status and depressive symptoms. Subjects and methods Sixty-six consecutive patients with chronic systolic HF, hospitalized in the Centre for Heart Diseases, Military Hospital (94% men, age: 61 ± 11 years, ischemic etiology: 63%, left ventricular ejection fraction: 32% ± 12%), filled in (during their hospital stay): (1) the Multidimensional Health Locus of Control Scale measuring three possible localizations of health control: “internality” (ie, the belief that health status depends only on personal decisions and behaviors); “powerful others externality” ([PHLC subscale] ie, the conviction that health depends on “powerful people” such as doctors, family members, close friends), and “chance externality” (ie, belief that health status is determined by chance, fate, or luck), and (2) the Generalized Self-Efficacy Scale. The results obtained by HF patients were compared to those reported by patients with other chronic diseases and healthy subjects. Results In patients with HF, internality was similar to values obtained by patients with diabetes, men after myocardial infarction, and women after mastectomy; and was lower than in healthy subjects. Powerful others externality was more pronounced in patients with HF as compared to other groups of patients and healthy people. Only women after mastectomy had higher scores of PHLC. In patients with HF, chance externality was similar to values reported in patients with renal failure, men after myocardial infarction, and women after mastectomy; and was less pronounced than in healthy subjects. The majority (77%) of patients with HF were characterized by a high sense of self-efficacy (>the 7th sten score), having the highest sense of self-efficacy among patients with other chronic diseases and healthy controls. Higher internality was accompanied by higher sense of self-efficacy (P < 0.05) in patients with HF. Subjects with high plasma N-terminal pro-B type natriuretic peptide (reflecting the disease severity) had the least pronounced internality (P < 0.05), whereas those with more advance depressive symptoms had the lower sense of self-efficacy (P = < 0.05). Conclusion Patients with systolic HF demonstrate a conviction that other people, including physicians, have a large influence on their health status, and at the same time are aware of the efficacy of their own activities in coping with the disease. Such a configuration of psychological features seems to be beneficial in the context of the developing modern strategies, which due to the improved cooperation between the physicians and the patients could enhance the compliance in patients with HF.

The influence of the sounds of crying baby and the sounds of violence on haemodynamic parameters and autonomic status in young, healthy adults

INTRODUCTION There is evidence that various stimuli affect the balance in the autonomic nervous system (ANS) and the functioning of cardiovascular system. OBJECTIVE The aim of the study was to assess whether the sounds of crying baby and the sounds of violence affected haemodynamic parameters and ANS in young, healthy adults and to measure differences in these reactions between the genders and these 2 stimuli. METHODS Haemodynamic parameters (measured non-invasively by the NEXFIN device), heart rate and blood pressure variability (HRV and BPV, respectively) and baroreflex sensitivity (BRS) were analyzed in 65 adults (21 women, mean age: 23years) during a 15-minute rest followed by the emission of two 5-minute acoustic stimuli: sounds of crying baby and sounds of violence emitted randomly and separated by a 4-minute pause. RESULTS Resting systolic blood pressure was lower, whereas indices of HRV (RMSSD, NN50, pNN50, high frequency component of HRV - HRV HF) and BPV (high frequency component - BPV HF) as well as BRS were higher in women as compared to men. During the emission of the sounds of crying baby, a decrease in diastolic blood pressure (DBP), systemic vascular resistance index, HRV HF and BPV LF (low frequency component of BPV) and an increase in stroke volume index were observed in the whole examined group, whereas during the emission of the sounds of violence subjects presented a decrease in DBP, mean blood pressure, HRV HF and BPV LF. The reaction to the sounds of crying baby (expressed as a decrease in HRV HF) was greater in women as compared to men (-0.28±0.49 versus -0.04±0.38ms(2), p=0.04). The comparison of the reaction between 2 stimuli revealed no differences. CONCLUSIONS The stronger decrease in parasympathetic drive in women exposed to the sounds of crying baby may be related to a particular role of this stimulus, which signals the babys distress and compels the caregivers to react.

Psychological gender of men with systolic heart failure: a neglected strategy to cope with the disease?

Diminished exercise capacity is a fundamental symptom of heart failure (HF), which is particularly disadvantageous for men for whom exercise capacity contributes significantly to their gender identity, self-esteem, and quality of life. In this study, we aimed to examine whether psychological gender would be different in men with systolic HF as compared with their healthy peers. The authors examined 48 men with systolic HF (age = 64 ± 10 years; body mass index = 28.3 ± 3.4 kg/m2; NYHA I/II/III [%] = 25/65/10; left ventricular ejection fraction [LVEF] = 32.1 ± 7.8%) and 15 age-matched healthy men. Based on the results of the Polish version of the Bem Sex Role Inventory, the examined men were divided into four types of psychological gender: “masculine” (M), “feminine” (F), “unspecified” (U), and “androgynous” (A). None of the men with HF presented M type of psychological gender, whereas this type was found in 27% of the healthy men (p = .0002). The prevalence of both A (38% vs. 47%) and F (10% vs. 20%, both p > .05) types of psychological gender was similar between men with HF versus without HF. More men with HF fulfilled the criteria of the U type of psychological gender as compared with healthy peers (51% vs. 7%, p = .002). Men with HF and the F type of psychological gender were treated with spironolactone more frequently than those classified with the U and A types (both p < .05). The lack of “psychologically masculine” and the overrepresentation of “psychologically unspecified” gender types in the HF group suggests that psychological gender may be affected among men with HF.

Hypercapnic Chemosensitivity in Patients with Heart Failure: Relation to Shifts in Type-1 Insulin-Like Growth Factor and Sex Hormone-Binding Globulin Levels

In patients suffering from heart failure (HF), autonomic imbalance develops even at early stages along with derangements of cardiopulmonary reflex control and abnormalities in metabolism of several hormones. In 34 men with stable systolic HF, we investigated hypercapnic chemosensitivity (HCS, liter/min·mm Hg) measured using the rebreathing method and defined as the slope of the regression line relating minute ventilation (VE, liter/min) to end-tidal carbon dioxide concentration (PETCO2, mm Hg). Serum levels of testosterone, dehydroepiandrosterone sulfate, type-1 insulin-like growth factor (IGF-1), sex hormone-binding globulin (SHBG), estradiol, and cortisol were measured using immunoassays. We found that there were no associations between HCS and clinical variables, applied therapy, and co-morbidities (all P > 0.2). Augmented HCS was accompanied by the significantly increased serum SHBG (when expressed in nM, r = 0.43, P < 0.05; when expressed as percentage of the age-matched reference values, r = 0.62, P < 0.001) and the reduced serum IGF-1 (when expressed in ng/ml and as percentage of the above-mentioned values, r = –0.49, P < 0.05, and r = = –0.47, P = 0.007, respectively). The HCS was not related considerably to serum levels of all the remaining analyzed hormones (all P > 0.2). Thus, it may be suggested that the hormone stimuli can noticeably modify the reflex mechanisms in cardiorespiratory control in the clinical setting of cardiovascular pathology.